Securing Access to Care for Seniors in Critical Condition Act of 2025
Summary
What This Bill Does
The Securing Access to Care for Seniors in Critical Condition Act changes when long-term care hospital discharges are exempt from Medicare site-neutral payment rules. Current law has exceptions such as the ventilator criterion. This bill adds a new high-acuity criterion for discharges assigned to a Medicare-Severity-Long-Term-Care-Diagnosis-Related-Group with a relative weight of at least 0.8, for discharges occurring on or after October 1, 2026. In practical terms, higher-acuity LTCH cases would receive LTCH payment treatment rather than lower site-neutral payment treatment, helping hospitals that treat medically complex patients but increasing Medicare spending relative to site-neutral reimbursement.
Who Benefits and How
Long-term care hospitals benefit because high-acuity MS-LTC-DRG discharges with relative weights of at least 0.8 can avoid site-neutral payment cuts. Critically ill Medicare patients benefit if LTCHs have stronger payment support to accept complex post-acute cases. Hospital discharge planners benefit from more stable LTCH access for patients who need intensive long-term acute care. LTCH clinicians benefit if payment policy better supports resource-intensive cases.
Who Bears the Burden and How
The Centers for Medicare & Medicaid Services must update LTCH payment rules and claims logic for the new criterion. Medicare contractors must apply the high-acuity test beginning October 1, 2026. The Medicare program and federal taxpayers bear higher payment exposure for qualifying LTCH discharges. Site-neutral payment advocates lose some savings from applying lower rates to LTCH cases.
Key Provisions
- Adds a high-acuity criterion to Medicare LTCH site-neutral payment exceptions.
- Requires an MS-LTC-DRG relative weight of at least 0.8 for the discharge fiscal year.
- Applies the new criterion to discharges occurring on or after October 1, 2026.
- Expands LTCH payment protection for medically complex Medicare cases.
Evidence Chain:
This summary is generated from the full bill text using AI analysis. Expand "Detailed Analysis" below for identified beneficiaries/burden bearers with clause-level evidence links.
At a Glance
What This Bill Does
Adds a high-acuity criterion to Medicare long-term care hospital site-neutral payment rules so discharges assigned to MS-LTC-DRGs with relative weights of at least 0.8 on or after October 1, 2026, avoid site-neutral payment treatment.
Key Policy Areas
Medicare, Hospitals, Long-Term Care
Primary Purpose
Adds a high-acuity criterion to Medicare long-term care hospital site-neutral payment rules so discharges assigned to MS-LTC-DRGs with relative weights of at least 0.8 on or after October 1, 2026, avoid site-neutral payment treatment.
Policy Domains
Resolution provisions
Identified Gains
- Long-term care hospitals
- Critically ill Medicare patients
- Hospital discharge planners
- LTCH clinicians
Identified Costs
- Centers for Medicare & Medicaid Services
- Medicare contractors
- Medicare program
- Site-neutral payment advocates
Sponsors
Legislative Progress
In CommitteeMr. Hern of Oklahoma (for himself, Mr. Boyle of Pennsylvania, …
Referred to the House Committee on Ways and Means.
Introduced in House
Stakeholder Effects
cui bono?How this legislation distributes effects. Mention counts reflect frequency, not effect magnitude.
Hospital discharge planners, Long-term care hospitals
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
We use a combination of our own taxonomy and classification in addition to large language models to assess meaning and potential beneficiaries. High confidence means strong textual evidence. Always verify with the original bill text.
Learn more about our methodology